RARE HIV STRAINS INTO PERSPECTIVE

Dec 12, 2000

Hello Ryan, thanks for all the insight. You do a valuable service! There seems to be a lot of worry on this forum regarding rare strains of HIV to include HIV-2 as well as the O & N strain of HIV-1. Wouldn't it be safe to say that if ALL strains of HIV that an HIV-1 test was designed to pickup were eliminated from the face of the earth, AIDS would be considered a very rare type of STD? I understand that HIV-2 is not very prevalent in the world and the CDC only recommends an HIV-2 antibody test if you had sexual contact, received blood and/or shared drug needles with an individual from Western Africa. Can you confirm this and maybe put this fear into perspective? Thanks!!

Response from Mr. Kull

Yes, there is a lot of worry on this site about strains of HIV that might be undetectable by standard antibody or viral tests on the market. Understandably so. After reading some of the following information, I hope that people's fears will be reduced. Researchers in the HIV field are continually monitoring the development of HIV in the world and are attempting to modify and improve tests so that current detection techniques improve in accuracy.

Following are some excerpts that I am including from different sources about the accuracy of HIV antibody tests in detecting different subtypes and groups of HIV. Please note that I present them chronologically so that you can have a sense of how things progress over the years:

From the CDC NAC (1997):

"Most antibody tests for detecting HIV-1 were developed with the B subtype of the virus. As the genetic composition of a particular virus diverges from the B subtype, the likelihood that the test will be accurate decreases. Most tests, however, do appear to be able to detect antibodies to most strains."

From HIV InSite (1998):

"Since this report, HIV test manufacturers have been tweaking their tests to make them more sensitive to group O. Until they can claim 100%, the FDA does not allow them to make any claims about being able to detect group O (say 80%).... New tests currently being reviewed by the FDA must be sensitive to Group O, so any new tests that will hit the US market in the next few years, for example Abbott's new Determine rapid test, are known to detect 100% of Group O."

From UNAIDS:

"Routine HIV tests which are currently being used for blood screening and diagnostic purposes detect virtually all subtypes of the human immunodeficiency virus. (Most companies have modified their assays so that they detect the newly identified HIV-1 group O strains.)"

According to an HIV expert that I spoke with today at a testing laboratory (whose anonymity I would like to respect), all EIA/ELISA tests that are manufactured in the U.S. are required by the FDA to demonstrate accuracy in detecting HIV subtypes and groups. According to this expert, a certain manufacturer was required to take its HIV antibody test off the market because it was found to be unreliable in detecting group O antibodies in Europe.

I found this information to be reassuring.

HIV-1/HIV-2 testing kits are becoming pretty standard in the world. HIV antibody tests remain some of the best detection tools in infectious disease medicine.

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